Hospice care is a unique wholistic care that seeks to provide for you and your families’ physical, psychosocial, spiritual, and emotional needs. You can expect to receive care that is coordinated by a hospice team (commonly known as the Interdisciplinary Group (IDG) or Interdisciplinary Team (IDT), and services that are directed by your Plan of Care.

What is the Admission Process?

There are a series of steps to the hospice admission process. These steps may occur separately or simultaneously. They are:

Your attending physician makes the hospice referral.

You sign the Certification of Terminal Illness and Election of Hospice forms.

You are admitted into the hospice of your choosing.

Patient Rights Notice is given to you and your family.

The initial and comprehensive patient assessment (RN assessment within 48 hours; Hospice team assessment within five calendar days) is performed.

Your hospice team coordinates your Plan of Care and services with you, your family and an attending physician.

Your hospice team trains and educates your family on drug and medical equipment management.

Periodic visits from your hospice team will occur, as well as ongoing assessment of yourPlan of Care and eligibility.

What is a Plan of Care?

Once eligible for hospice, your individualized written plan of care, called Plan of Care (POC), will be established by your hospice team in collaboration with you or your representative, the attending physician (if any), and your primary caregiver before any services are rendered. This ‘roadmap’ of care will include all services necessary for the palliation and management of your terminal illness, related conditions, and may include problems, interventions and goals.

Your hospice must ensure that you and your primary care giver(s) receive education and training as appropriate to their responsibilities for the care and services identified in the POC.

Your hospice team (in collaboration with your attending physician, if any) will review, revise and document your individualized plan as frequently as your condition requires, but no less frequently
than every 15 calendar days.

What Are Levels of Care?

There are four levels of hospice care defined by law and paid for by Medicare, Medicaid, and most other insurance plans. The hospice or the attending physician will determine what levels of care you need by using standardized criteria. Not every level of hospice provides 24-hour care, and you may not use or need all levels of care. The goal of hospice is to empower your family by providing education and support.

ROUTINE CARE: You will receive hospice services at home or in a home-like setting, such as nursing home, assisted living facility or a hospice residential facility. Your family provides the primary care with the assistance of the hospice team.

CONTINUOUS CARE: Skilled nursing services are provided in your place of residence to help during a crisis period.

INPATIENT CARE: This care is provided in a facility (hospital, nursing facility, or hospice freestanding inpatient facility) for symptoms or a crisis that cannot be managed in your residence. Inpatient care is provided for a limited period of time, as determined by your physician and your hospice team.

RESPITE CARE: This service is provided in a facility (hospital, nursing facility, or hospice freestanding inpatient facility) and is designed to give your caregivers a rest. Respite care is up to five days and nights at a time. This service is often used to provide a break so your caregivers can participate in other family activities, such as holiday celebrations, or just to give rest and relief for a few days.

Hospice services are delivered on an intermittent basis, as needed by you, through a professional hospice team.

Your hospice team will include, but is not limited to:

PHYSICIAN: Your personal physician and the hospice physician work together to plan your medical care.

NURSE: The nurse is the liaison between you and the physician and other health care professionals. The hospice nurse makes intermittent visits to monitor and evaluate your condition. The nurse provides the you and your family with information about the illness and helps manage your pain and disease symptoms.

MEDICAL SOCIAL WORKER: The social worker assists your family with financial, insurance and legal issues, and helps them understand the personal and social challenges of illness, disability, and the dying process.

SPIRITUAL/PASTORAL COUNSELOR: Hospice spiritual counselors, usually called chaplains, will help you address life closure and the meaning of life. In accordance with your beliefs or practices.

Other professionals that may assist in care are:

HOME HEALTH AIDE: Home health aides provide a break for your caregivers in the normal routine of personal care and they offer both physical and emotional support. Personal care services are provided to you on an intermittent basis.

THERAPIST: Physical, occupational, and speech therapists are available through hospice to help you maintain comfort or quality of life. Some hospices may also provide complimentary therapies such as music, art, pet and massage.

BEREAVEMENT COUNSELOR: Bereavement counselors provide emotional support to your family members through either one-on-one counseling and/or organize support groups.

VOLUNTEER: Trained hospice volunteers perform many functions including sitting with you, running errands for you or your caregiver, providing emotional support, and relaying information to other members of the interdisciplinary group for follow-up.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was established to protect your health information by setting rules and limits on who can look at and receive this information. Among different uses, your health information can be used and shared with your family, relatives, friends, or others you identify who are involved with your health care or your health care bills, unless you object. Health surrogates or proxies, have the right to choose, on your behalf, who may or may not receive your health information.

Most hospice patients are eligible for Medicare or Medicaid, which cover all aspects of hospice care and services. There is no deductible for hospice services although there may be a very small co-payment for prescriptions and for respite care.

Private health insurance plans, often called ‘self-pay,’ offer a hospice benefit, but the services covered may differ from Medicare as well as from one another. Contact your insurance provider for more information about hospice coverage. Military families have hospice coverage through Tricare.

It is the hospice philosophy to provide access to all who choose this type of care, regardless of ability to pay. Most hospice programs also provide care for those who have no source of hospice benefit coverage.

Many hospice programs conduct fund-raising events in their communities to help support this philosophy of care to all persons.

To ease both yours and your families’ concerns, the hospice admissions staff and social workers will try to ensure that payment issues are handled in an uncomplicated manner.

Grief is different for each person and each situation. People can grieve over different types of loss, such as the loss of a job, a marriage, a pet, or a loved one. Although each person grieves differently, there are some common reactions to grief.

These can include:

A sense of numbness and shock

Tightness in the throat, heaviness in the chest or a feeling of emptiness

Restlessness and a tendency to wander around the house or familiar places

Grief bursts marked by crying easily, unexpectedly and intensely

Changes in appetite and/or sleep

Decreased energy and loss of interest in social activities or work

Difficulty concentrating

Sensing the presence of the deceased

If you are experiencing these sorts of symptoms, you may be grieving. One of the many benefits that hospice can offer is grief and bereavement support for patients, families and friends. Contact your local hospice provider to find what grief support services are available.

For those enrolled in hospice, bereavement support starts at the first contact with hospice and continues throughout the loved one’s illness. Bereavement support then continues for 13 months following their death. For those who are grieving the loss one of someone who was not enrolled in hospice, there are still a variety of grief support options available. Contact your local hospice provider to find what grief programs they offer.

All hospice providers offer grief & bereavement support programs, although these vary from hospice to hospice. Support can be provided through one-on-one sessions or in a group setting. Contact your local hospice provider and see what type of services they offer.

Many hospices provide grief and bereavement support to everyone, regardless of when their loved one died or whether or not they utilized hospice care. These grief programs often include support groups, grief camps, and community memorial services. Contact your local hospice provider to find out about their grief support programs.

Many hospices offer bereavement services for youth that can include grief camps, support groups, one-on-one counseling, or educational resources. Some hospices even provide grief support in area schools. Hospices can also provide much needed support and information to adult caregivers. Contact your local provider and ask about their services for bereaved children and teens.